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	}
?>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01//EN" "http://www.w3.org/TR/html4/strict.dtd">
<html>
<head>
<title>APO Cooperative Database System - Add Planholder</title>
<meta http-equiv="content-type" content="text/html; charset=iso-8859-1">
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<body>
<div class="container ui-corner-all">
	<div class="header ui-corner-top">
  <h1>APO Cooperative Database System</h1>
</div>
<div class="divider"></div>
  <div class="wrapper">
    <div class="content">
    	
      	<form action="planholderRecordController.php" method="post">
        <input type="hidden" name="accountExecutive" value="<?php echo $_SESSION['user'] ?>" />
        <table>
			<tr>
            	<td>Policy Number</td>
	            <td><input type="text" name="policyNumber"></td>
            </tr>
            <tr>
				<td>Last Name</td>
                <td><input type="text" name="lastName"/></td>
            </tr>
            <tr>
				<td>First Name</td>
                <td><input type="text" name="firstName"/></td>
            </tr>
            <tr>
				<td>Middle Name</td>
                <td><input type="text" name="middleName"/></td>
			</tr>
            <tr>
				<td>Contact Number</td>
                <td><input type="text" name="contactNo"/></td>
            </tr>
            <tr>
				<td>Birthday</td>
                <td><input type="text" name="birthday" class="datepicker" readonly="readonly"/></td>
            </tr>
            <tr>
				<td>Application Number</td>
                <td><input type="text" name="applicationNo"/></td>
			</tr>
            <tr>
				<td>Type of Plan</td>
                <td>
                	<select name="type">
							<option value="Harmonious">Harmonious</option>
							<option value="Glorious">Glorious</option>
							<option value="Fraternal">Fraternal</option>
							<option value="Equitable">Equitable</option>
							<option value="Divinity">Divinity</option>
							<option value="Celebrity">Celebrity</option>
							<option value="Bossom">Bossom</option>
							<option value="Supreme">Supreme</option>
						</select>
				</td>
            </tr>
            <tr>
				<td>Term</td>
                <td><input type="text" name="term"/></td>
			</tr>
            <tr>
				<td>Mode of Payment</td>
                <td>
                	<select name="mode">
								<option value="Monthly">Monthly</option>
								<option value="Quarterly">Quarterly</option>
								<option value="Semi-annually">Semi-annually</option>
								<option value="Annually">Annually</option>
							</select>
				</td>
            </tr>
            <tr>
				<td>Plan Value</td>
                <td><input type="text" name="planValue"/></td>
            </tr>
            <tr>
				<td>Effective Date</td>
                <td><input type="text" name="effectiveDate" class="datepicker" readonly="readonly" /></td>
            </tr>
            <tr>
				<td>Due date</td>
                <td><input type="text" name="dueDate" class="datepicker" readonly="readonly" /></td>
            </tr>
            <tr>
				<td>Branch</td>
                <td><input type="text" name="branch"></td>
            </tr>
            <tr>
				<td><input type="submit" value="Add Planholder"/></td>
            </tr>
		</table>
        </form>
       
    </div></div>
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  	<div class="userstat">
    <?php
    	echo "<p>You are logged in as: <br/>".$_SESSION['name']."<br/></p>";
			echo "<a href=\"\">Edit</a> your profile<br />";
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	?>
    </div>
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    <div class="navheader ui-corner-top"></div>
    <div class="userstat">
    	<a href="employeepage.php">Back to profile page</a><br />
    	<a href="addPlanholderView.php">Add Planholders</a><br />
        <a href="viewStartedContractsView.php">View Started Contract</a><br />
    </div>
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